-Futile medications in cancer patients.

With early diagnosis and better therapy, life expectancy/survival in cases of cancer has improved dramatically. In many cases of cancer, all that is required is good palliative care.

Such patients take many medications, and many of them may be unnecessary. Now there is a study regarding Futile medication use in terminally ill cancer patients.

Futile medications were defined as unnecessary ( no anticipated short term benefit to patients for survival, quality of life or symptom control) or duplicate ie 2 or more drugs from the same pharmacological class.

The results were better than i expected. About 20% (only?, i think more) terminally ill cancer patients are on futile medications, most commonly Statins (56%). The most common duplication of medication was for the benzodiazepines class.(no surprises there!).

As a doctor, many-a-times i am “forced” to write medications i know is not required by the patient. I usually use this tactic as a placebo.What do you think of use of such “Futile” medications in cancer patients?

-Palliative care in Cancer-

Most People do not realize the importance of palliative care. in Cancer.

Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay or reverse progression of the disease itself or provide a cure. Palliative care is an interdisciplinary team approach, with a focus on comfort and quality of life rather than prolongation of life
or “cure” for a patient.

With better drugs and technology, we are dramatically improving the survival in cancer patients. New studies are carried out everyday to find new cures.Unfortunately, the research frequently focuses exclusively on survival as an endpoint, leaving surgeons with little information on an
intervention’s impact on QOL (Quality of Life).

There are multiple examples of problems that can affect the QOL for a patient facing the end of life. These can be categorized based on symptoms or systems in the body that are affected. Major symptoms include pain, dyspnea, anorexia, and depression. Related to body
systems, one can imagine a potential symptom related to each body system. Neurologic problems include fatigue, headache and other pain syndromes, and delirium. Pulmonary complications include dyspnea, fatigue, and immobility. Cardiac symptoms include shortness of breath, fatigue, and pain. Gastrointestinal problems include obstructions, diarrhea, nausea, vomiting, and anorexia. Musculoskeletal complications include fractures, functional loss, and pain. Epidermal problems mainly focus on wound problems, but also can include poor cosmesis and pain. Complications related to the hematologic system include infection and fatigue. Urologic problems include ureteral obstructions, bleeding, and pain. It is this compendium of problems that palliative care research focuses on, rather than increase in survival time or cure. We need more research to focus on these problems of the people who survive cancer.

There are many potential reasons for the lack of palliative care research. Many of them are related to ethical aspects of this research.There are also innate barriers, such as a lack of trained researchers and the challenges of subject recruitment.

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